Healthcare Provider Details

I. General information

NPI: 1790684165
Provider Name (Legal Business Name): NEW MEXICO FITNESS PHYSIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 WYOMING BLVD NE STE 8B
ALBUQUERQUE NM
87109-4869
US

IV. Provider business mailing address

6100 E CENTRAL AVE STE 3
WICHITA KS
67208-4237
US

V. Phone/Fax

Practice location:
  • Phone: 855-749-7461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRIAN HERSHBERGER
Title or Position: CCO
Credential: PT, MPT
Phone: 301-787-0989